Tag Archives: Infants

There’s a lot of mights and maybes, but according to scientists, evidence is accumulating that food allergies in children might be prevented by feeding infants peanuts and other allergenic food in their first year of life.

That finding would challenge the recommendation of the World Health Organization that babies be fed exclusively breast milk for the first six months of life.

“At least as far as peanut is concerned, I would recommend parting from that,” Dr. Gideon Lack, professor of pediatric allergy at King’s College London, told the N.Y. Times.

Dr. Lack was the senior author of a study last year that found feeding peanuts to young children starting when they are 4 to 11 months old sharply reduced the risk of their developing peanut allergies. That upended the conventional wisdom that it is best to avoid introducing peanuts until children are older.

Those results are already starting to affect feeding practices, but they left several unanswered questions. Now, some of those questions were answered by two additional studies that are being published in The New England Journal of Medicine and presented here at the annual meeting of the American Academy of Allergy, Asthma & Immunology on Friday.

One question was whether children who consume peanuts from an early age will still remain free of allergies if they stop consuming them. The researchers followed the children from the original study for another year, from the time they turned 5 until they turned 6. For that year, they were not supposed to eat peanuts at all.

The results were reassuring. There was no big increase in allergies.

“It tells you the protective effect is stable,” Dr. Lack said.

Another question was whether the early feeding technique could be applied to other types of foods and to children at normal risk of allergies. (The original study involved children deemed to have a high risk of peanut allergy.)

The researchers conducted a second study at King’s College London involving 1,300 infants who were 3 months old and being fed only breast milk. Half were randomly assigned to continue on only breast milk until 6 months of age, which is the recommended practice in Britain. The other half were to be regularly fed small amounts of peanut butter and five other allergenic foods: eggs, yogurt, sesame, white fish and wheat. The children were assessed for allergies when they turned three.

Overall, 5.6 percent of the babies who were fed the allergenic foods early developed an allergy to at least one of the six foods, a modest improvement from the 7.1 percent in the breast-milk-only group. However, the difference was not statistically significant, meaning it could have occurred by chance.

One problem was that fewer than half the parents in the early-introduction group actually fed their children the required six foods on a regular basis. But when researchers looked only at those children whose parents adhered to the feeding regimen, there was a statistically significant reduction in allergies. Only 2.4 percent of those children developed a food allergy, compared with 7.3 percent of those whose parents faithfully stuck to breast milk only for six months. There were also significant reductions in peanut allergies alone and egg allergies alone.

In a commentary in The New England Journal of Medicine, Dr. Gary W.K. Wong, a pediatrician at Chinese University of Hong Kong, cautioned about jumping to conclusions. He said that in any case, the fact that so many parents did not stick to the regimen suggested it was too demanding to be practical, and that less burdensome ways must be found to introduce allergenic foods early.

“In the meantime,” he said, “evidence is building that early consumption rather than delayed introduction of foods is likely to be more beneficial as a strategy for the primary prevention of food allergy.”

This is not the advice of UK health types, but according to a new review published in the Journal of Health Visiting and cited in Parent Dish, nutritionist Dr Juliet Gray, said mothers may be unwittingly putting their children at greater risk of allergy by an avoidance strategy.

She said research suggests delayed introduction of potential food allergens, such as eggs, during weaning may actually be counterproductive. In contrast the introduction of these foods while breastfeeding, between the ages of 4-7 months, could protect against developing allergies to these foods.

Dr Gray said two trials are being carried out to test whether the approach works and two government committees are also reviewing the current advice on infant feeding and food allergy.

She said “Eggs are highly nutritious, containing key nutrients including high quality protein, vitamin D, selenium, choline and omega-3 fatty acids, several of which are not found in many other foods.

“Our review concluded that mums and their babies can be encouraged to eat eggs, as this could have a positive effect in terms of nutritional intake and may also help immune tolerance of eggs.

The British Egg Industry Council (BEIC) said the launch of a strict code of practice 15 years ago has been so successful that salmonella has been ‘effectively eliminated’, with 90 per cent of British eggs now laid by salmonella-vaccinated hens. Each egg is stamped with a lion mark and a best-before date on the shell.

NHS Choices still advises pregnant women to avoid eating soft-boiled eggs, or giving them to babies after weaning because of the salmonella risk.

And just a fraction of babies are given eggs at six months because of allergy concerns.

I didn’t know much about infant botulism until a call came into the toll-free line that was run out of our Guelph lab. The inquirer wanted to know what the risk of a less-than-one year old kid acquiring botulism from cereal like honey nut cheerios was. After having two kids I now know that Cheerios are often one of the first introduced solid foods – but this was back in my grad school days when babies were an unknown to me.

I was sitting close to Sarah Wilson, then infocenter manager extrordinare, when the call came in and we chatted about cereal processing and whether the baking process would inactivate C. botulinum spores. Spores, a dormant-but-protected state that some bacterial cells resort to when stressed, are tough to address because they are pretty heat-stable. Once the spores get into the digestive system of an infant, which hasn’t fully developed and has a gastric pH higher than 4.6, they can germinate and outgrow. The result is a cell that multiplies and secretes a toxin as a byproduct. The rub, for the honey industry is that consumption is a factor in almost all infant botulism cases. There is also some evidence that infant botulism may be a risk factor for SIDS.

The literature wasn’t much help on the cereal question – we knew that 240-250F was necessary to inactivate the spores but didn’t know what the honey processing/cereal baking situation was. We called a couple of processors’ customer service folks and the response we got was that the incoming honey could be contaminated and that the processing likely wouldn’t reduce the risk. Who knows whether this is evidence-based or not. If the cereal companies are addressing this risk somehow they should share that info.

Public health folks like the CDC in the U.S. and recently Health Canada suggest that honey is an avoidable source of C. botulinum spores and have warned against honey and honey-product consumption for infants. The honey industry’s best practices include labeling warning parents about risks.

Tragic stories around infant botulism still have popped up over the past couple of years.In Philadelphia Infant Amanda Zakrzewski was diagnosed with infant botulism and had to undergo 9 days of antitoxin treatment in hospital. Amanda wouldn’t eat, her eyes glassed over and she wasn’t able to suckle due to the paralysis the botulinum outgrowth caused. The result was months of rehab.

In 2011, 16-week-old Logan Douglas was temporarily blinded and paralyzed from infant botulism. He fully recovered after six months, but at one point the illness was so severe that doctors had discussed turning off life support systems as the toxin was attacking his body. His mother revealed following the incident that she had fed Logan honey.

Keona Hinkel has been on a breathing machine at the Rocky Mountain Hospital for Children for two weeks, but she’s improving.Doctors think indirect honey exposure or contaminated soil from a home under renovation may have sickened Keona.She wasn’t fed honey but mother Kari Hinkel said that she cooked with honey. It’s possible she touched her daughter with it or it got on her pacifier.

Wandering around Brisbane on a Saturday afternoon we came upon the splash park and beach at Southbank, close to downtown.

Sorenne did some impromptu playing, and I noticed at least three little kids running around naked. The lifeguard soon happened along and told the parents to at least put a diaper on the toddlers. I asked the lifeguard, was that to prevent little ones pooping in the splash park and he said, he didn’t know, it was just policy.

It’s a good policy.

WIS reports the Splash Pad at Drew Wellness Center is back open after being closed for nearly a month when a child was found sick with a case of the parasite cryptosporidium.

Since then, the city has revamped its procedures for keeping track of how the pad is maintained.

Ray Borders-Gray with the Drew Wellness Center, said,

"After what happened, we took a good hard look how we were doing business. The standard Operating Procedures for the Splash Pad is now written down, all staff have taken a look at it, the standards are now here on site, so if anyone has any questions about what should happen, when it should happen. …

"We are asking people to wear the proper swim attire. We want to make sure the little ones are in the diaper swim pants and we ask that people do not bring their pets to the Splash Pad."

Amy, Sorenne and I go grocery shopping fairly frequently. The 11-month-old is curious about everything, a trait I called the day she was born; she’s alert, curious and increasingly mischievous.

When she was strong and co-ordinated enough to sit on her with a seatbelt on the seat behind the handle, a battle of wills soon emerged as Sorenne would have her hands on the handle, then in her mouth, or worse, would try to suckle the handle.

At this point I become much more rigorous and consistent about using those sanitary wipes to wipe down the shopping cart seat and handle.

Last year, USA Today reported that supermarkets and other retailers that provide shopping carts are increasingly looking to limit germ exposure for customers and their families.???, making sanitary wipes more readily available and in some cases, installing a whole cart cleaning system like this one in Wisconsin (photo by Peter J. Zuzga, for USA TODAY)

The trend continues to grow. Newspuller Gonzalo was in the Manhattan (Kansas) Target store recently and snapped these shots (below).

Parents and caregivers also have to think like the bad bug: like, don’t give the kids packages of raw meat to play with or leave within reach. Olga Henao, an epidemiologist for the U.S. Centers for disease control told USA Today last year that doing so triples the chance they may contract salmonella and quadruples it for campylobacter.“Infants can become ill when they transfer bacteria from the packaging into their mouths.”